Calling In Sick: Dealing With Mental Illness At Work, Part 2
Second in a series about handling the sensitive issues posed by psychiatric disorders in the workplace. Here we explore ways to answer difficult interview questions and challenge employers when they request personal health information.
If you are a nurse who suffers from a serious mental illness such as bipolar disorder or schizophrenia, you probably have had difficulties in obtaining, and then keeping a job. Many of us have spotty work histories filled with multiple jobs where we stayed only a brief time (AKA job-hopping) and jobs we've lost because of inconsistent performance or poor attendance. Others have spent time on disability due to severe MI that kept them from working for months or even years; once stabilized, they become bored and restless, and decide that it's time to go back to work.
Obviously, there are going to be some gaps in your employment history that you'd just as soon not have to explain. Say you've been inpatient and then had to follow up with intensive outpatient treatment, or you left your last job without notice, and/or you took a few months off to heal. Now you want (and need) to get back into the working world, but first, you have to figure out your next career move.
It's only natural to have reservations about this process. You've heard the horror stories about interviewing and being asked questions that you'd rather not answer; you've heard stories about nurses who had to supply a health history and med list to Employee Health. How do you dance around these delicate situations without either telling the honest truth, or furnishing false information that will get you fired if it's ever discovered?
Though there are no foolproof methods, here are a few pointers for interviews.
One of the most common questions asked of applicants with gaps in employment is, of course, why you left the previous job and what you did during your hiatus. This can be hard to explain when you had a nervous breakdown and then spent some time in the psych unit getting straightened out.
One way to handle this is to say you left to care for someone close (not your frail, elderly grandmother---everyone has one of those!) who suddenly became acutely ill; the prospective employer doesn't have to know that the person who needed the care was YOU. Be sparing with details; for one thing, the interviewer really doesn't care, and for another, you don't want to tell a story so elaborate that you'll forget some small thing and expose your truth-stretching to the light of day. OR---you can say that you yourself were ill, but that you were treated and the problem no longer exists. They don't need to know what kind of illness you had, and in fact have no right to know. That is personal health information protected by HIPAA.
Which leads to another critical matter of concern: the dreaded employee "physical". This is something I personally have never had to undergo, with the exception of the urine drug screen and TB testing. But it's a common enough requirement to present a problem for the nurse with a mental health history that s/he would rather not share with an employer.
Hopefully, you'll have done your homework and applied at a facility which doesn't ask for PHI. Talk to people who work there, ask them how they like working for this company, and casually ask them what is involved in the hiring process. If they tell you they had to supply their health information and a med list, you may want to bypass that company and apply somewhere else; but if your employment options are limited, you may have little choice but to proceed with the application.
If/when you are faced with disclosing your medical history and/or furnishing a med list to employee health, ASK why that information is needed, what it is to be used for, and who may have access to it. In good facilities, only the employee health and infection control nurses can see your information; managers and company officers have no authority to access it, and they can even face sanctions for attempting to view it.
Remember, we do not give up our right to privacy when we become healthcare professionals! Insist upon complete confidentiality when providing your PHI to anyone outside your doctor's office. If it cannot be guaranteed, you're better off looking elsewhere, even if you have to commute.
So why all the secrecy? Why not tell a prospective employer, your boss, or your co-workers about your mental health condition? You know it's not your fault, nor is it a moral failing. You do everything you can to manage it, including taking your medication and seeing your doctor regularly---what is there to be ashamed of? Why must you hide it?
Short answer: you don't, if you're lucky enough to work in an environment that's nurturing and accepting, like my current workplace. Unfortunately, however, most are NOT like that, and nurses who disclose a psychiatric diagnosis---whether voluntarily or through an exacerbation of their illness---all too often find themselves unemployed in some fashion. Even if they remain on the job, they are all too often passed over for promotions and discriminated against in other, more subtle ways, such as being left out of committees and disciplined for mistakes that other nurses get away with routinely.
Ultimately, it's up to the individual as to when, how, and whether to disclose a mental illness that may affect them at work. Now I'd like to invite you, the membership, to share how you have handled these issues, both now and in the past, as well as to offer suggestions to other nurses who are struggling.
To be continued.....Last edit by Joe V on Oct 16, '13
About VivaLasViejas, ASN, RN Guide
Joined: Sep '02; Posts: 26,735; Likes: 43,522
RN and blogger extraordinaire; from OR , US
Specialty: 20 year(s) of experience in LTC, assisted living, geriatrics, psychOct 15, '13I was on Social Security disability for 11 years due to agoraphobia which left me unable to leave my home for the first 3 of those years. When I decided it was time to try going back to work, I did so very gradually by getting into private duty, working only 1 shift a week in the beginning. I explained the gap in my employment history by saying I had stayed home to raise my daughter which was partially true. I started private duty after being on disability for about 5 years. Eventually I was able to return to full time work & haven't had to retreat back into my house since.
As far as the pre-employment physicals go, every hospital job I've had since I got off disability has asked my medical history & medications I take. I NEVER disclose my mental health history. The only thing I take for my bipolar is Cymbalta & when asked what I take it for, my answer is "chronic pain from rheumatoid arthritis". They have no way of finding out that's not the reason I take it. I also do make sure that my supervisors or managers will not have access to my health information. So far this has worked for me.Oct 15, '13I wonder why it is that so many employers seem to think that healthcare professionals don't have a right to privacy? And how is it that they're allowed to exploit that for all it's worth? I don't see this happening with jobs outside of nursing; I recently went through an interview process for a crime-victim advocate position and my health history never even came up. The state government didn't care either, when I applied for a surveyor position. All they cared about was whether I could pass a drug screen and a TB test.
Then again, the SNF where I'm working now doesn't ask about a nurse's health or the meds s/he is taking. Thank goodness some companies still believe in leaving their employees' private lives alone.Oct 16, '13Indeed. I just got a job with one hospital system that does not even do drug screens, let alone ask for my health history.Oct 16, '13Not going to disclose my medical history to any employer - including the fact I recently started in Pristiq for depression/anxiety issues. Unfortunately, as others have posted on here/other threads, all too often being completely honest can cause one to lose a job or for the information to be used a leverage in a situation where it really isn't relative. I believe (though I may be incorrect) that the employer wanting to know is really about possible workmans comp/legal type situations - a cover their own butt deal.
I've only been asked about employment gaps once - and I said basically what Viva said - that I was caring for someone close to me. I have started/stopped a few jobs quickly (like within a few days/weeks). I am not proud of it and I don't place those on my resume. Right or wrong. Self protection, when living with a mental health issue, I have learned, becomes priority. Unfortunately, there is still a stigma attached and it seems to be more so if it's someone in a care giving profession.Oct 16, '13I just started a job... did the whole physical, everything. I was asked if I had a DX OF DEPRESSION, anxiety, etc. Do you think I said yes/ hell no. I lied. how are they ever going to even know? no waaaay was i disclosing that. they dont need to know.Oct 16, '13and the employee assistance program??? lmao....... i called them a few years ago, and wanted advice about my daughter who was having anger issues, and wanted tips on how to deal, and help her deal. I have 10 YR old in the house as well.................the first thing that was said to me was that she was mandated to report to cps or the police or whatever that i had a minor child in the house and that this could be considered as abuse. for him to witness this,,,....well the incident i initially explained , the 10nyr old wasnt even IN the house. I was all set.I terminated my call, and said to myself :***" are they here to HELP or hurt? NEVER MIND GOING TO ANYBODY RELATED TO MY EMPLOYER REGARDING MENTAL HEALTH ISSUES...... I hAVE xanax prn... i told them i use it to sleep occasionally.... thats all i told them because i knew it would show up on the drug screen. this is sooo hard.Oct 16, '13to add: my 10 yr old was in no dangeR whatsoever, and not even close to being abused or neglected. but i call this EAP **** program and think i could get some guidance/help.... first sentance i was threatened with a cps case!!!! yeah i was real comfortable after that......Oct 16, '13Has anybody gone to their employers "Employee Assistance Program" for issues with their anxiety/depression?Oct 16, '13Yes & everything I said went right back to my manager & HR. A month later I was terminated! I now know EAP is not a good thing!Oct 16, '13I disclosed that I had a history of depression which I treated with therapy and meds, but stated that at this point I was not in therapy and had weaned myself off all meds -- which is true as far as it goes. I feel that this covers me for disclosing past conditions as well as covering me should I have a relapse in the future that renders me unable to work.
Right now I am doing really well and I love working. But if that all falls down I DO want something on my record that says, "Yes, I said I had this in my past, you can't accuse me of deceiving you."
Just trying to CYA as best I can...Last edit by KnitWitch on Oct 16, '13 : Reason: Typing is hard...Oct 16, '13I'm really glad you wrote this. I am on a few meds, and really don't think its any of anyone's business besides mine and my Doctors. I know employers ask for this stuff now, my last one did. I wasn't on some of the ones I am on now back then, but I remember being annoyed that they had to request it. Now I know what questions to ask when this happens again.Oct 16, '13I have never called the EAP, I would probably be afraid to. I have a lot of gaps in my employment & a lot of employers. I go on interview after interview & they always ask why. It's SOOO hard to answer. I know that is one of the reasons I am currently unemployed. I'm so stressed & it's throwing me into a bad depression. Do I even want to try to get my RN when I'm still the same person? When the same things will happen. When the economy still sucks. I'm so confused at this point. But no employer has ever asked about my health history or meds. I have had to tell them about my epilepsy because I can't work nights but that's it. But I will never come forward & tell them I'm bipolar.
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